Healthcare Provider Details

I. General information

NPI: 1396853156
Provider Name (Legal Business Name): JASON A CURTIS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

347 MAIN STREET
GORHAM ME
04038
US

IV. Provider business mailing address

347 MAIN ST
GORHAM ME
04038-1338
US

V. Phone/Fax

Practice location:
  • Phone: 207-839-3006
  • Fax: 207-839-4593
Mailing address:
  • Phone: 207-839-3006
  • Fax: 207-839-4593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3630
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: